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JENNIFER J LACKMAN PA
NPI 1184015414
Physician Assistant in Grand Rapids, MI

Active since February 09, 2015PECOS EnrolledAccepts Medicare Assignment
310 LAFAYETTE AVE SE, GRAND RAPIDS, MI 49503(616) 685-8200(616) 685-8202 Get Directions Write a Review

NPPES record last updated: April 6, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Apr 6, 2022, Nov 6, 2018, Dec 1, 2017 and 1 more (4 updates tracked since 2016).

About Jennifer J Lackman Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JENNIFER J LACKMAN PA (NPI 1184015414) is an individual physician assistant in Grand Rapids, Michigan, licensed in California (PA55661) and active in the NPI registry since February 2015. She is enrolled in Medicare PECOS, is affiliated with Mercy Health Saint Mary's, and is a graduate of Emory University School Of Medicine (2014).

NPPES Registry Identity

NPI1184015414
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameJENNIFER J LACKMANCredential: PA
Location Address310 LAFAYETTE AVE SEGrand Rapids, MI 49503-4693
Mailing Address5900 Byron Center Ave Sw, Attn Medical AdministrationWyoming, MI 49519-9606
Phone(616) 685-8200
Fax(616) 685-8202
Sole ProprietorNo
Medical School CMSEmory University School Of MedicineGraduated 2014
Enumeration DateFebruary 9, 2015
Last NPPES UpdateApril 6, 20224 updates tracked since enumeration
NPPES CertifiedApril 6, 2022
✔ NPI 1184015414 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
Licenses✔ Licensed in CA · PA55661✔ Licensed in MI · 5601007301
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
310 LAFAYETTE AVE SE, Grand Rapids, MI 49503
Open in Google Maps ↗

Other Names 1

Former Name (1)Jennifer J Richardson Pa

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, Oscar Insurance Company and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jennifer J Lackman Pa is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4284952367
PECOS Enrollment IDI20150422000462
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Mercy Health Saint Mary's

Acute Care Hospitals · Grand Rapids, MI
4/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number230059
Location200 Jefferson Avenue SEGrand Rapids, MI 49503 · Kent County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 49503 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.74 typical visit price
range $54.34 – $166.68
Typical copayment $21.18 (range $13.58 – $41.67)
Most-billed visit code 99203
Established Patient
$68.07 typical visit price
range $17.09 – $135.40
Typical copayment $17.01 (range $4.27 – $33.85)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PAUL D HARRIS DO
Internal Medicine (Pulmonary Disease)
310 LAFAYETTE AVE SE, STE 415
GRAND RAPIDS, MI 49503
Kent County (616) 685-5666
DR. MARTIN P. GREYDANUS M.D.
Specialist
310 LAFAYETTE AVE SE, STE 400
GRAND RAPIDS, MI 49503
Kent County (616) 752-6525
GRAND RIVER ENDOSCOPY CENTER, L.L.C.
Clinic/Center (Ambulatory Surgical)
310 LAFAYETTE AVE SE, SUITE 200
GRAND RAPIDS, MI 49503
Kent County (616) 752-5890
ORENA J KIRCHNER FNP
Nurse Practitioner (Family)
310 LAFAYETTE AVE SE, SUITE 400
GRAND RAPIDS, MI 49503
Kent County (616) 752-6525
CHRISTOPHER JOHN MURPHY MD
Internal Medicine (Gastroenterology)
310 LAFAYETTE AVE SE
GRAND RAPIDS, MI 49503
Kent County (216) 536-1528
LUCY LEDESMA NP
Nurse Practitioner (Adult Health)
310 LAFAYETTE AVE SE, STE 410
GRAND RAPIDS, MI 49503
Kent County (616) 685-8200
DR. LENNOX HUGH FORREST PH.D.
Psychologist (Counseling)
310 LAFAYETTE AVE SE, SUITE 325
GRAND RAPIDS, MI 49503
Kent County (616) 249-8486
GRAND RIVER GASTROENTEROLOGY PC
Internal Medicine (Gastroenterology)
310 LAFAYETTE AVE SE, SUITE 400
GRAND RAPIDS, MI 49503
Kent County (616) 752-6525

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jennifer Lackman's NPI number?

The NPI number for Jennifer Lackman is 1184015414. It was assigned to this individual provider in the NPPES registry on February 9, 2015. The provider is also known as Jennifer J Richardson PA.

Where is Jennifer Lackman located?

Jennifer Lackman practices at 310 Lafayette Ave SE, Grand Rapids, MI 49503. The listed phone number is (616) 685-8200.

What is Jennifer Lackman's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Jennifer Lackman enrolled in Medicare?

Yes. Jennifer Lackman is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Jennifer Lackman accept?

Health plans from Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, Oscar Insurance Company and Priority Health list Jennifer Lackman as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Jennifer Lackman affiliated with any hospitals?

According to CMS data, Jennifer Lackman is affiliated with Mercy Health Saint Mary's.

When was this NPI record last updated?

The NPPES record for Jennifer Lackman was last updated on April 6, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.